Impact of Socio-Demographic Variables on Maternal Breastfeeding Knowledge and Practices: A Cross-Sectional Investigation in The Gambia

  

    
Aspect    of knowledge
    
Number    of respondents (n = 500), n (%)
  
  

    
Breast milk should be baby’s first    feed (yes)
    
499 (99)
  
  

    
Baby should be put to the breast    within hours of birth (yes)
    
456 (91)
  
  

    
Colostrum should be fed to the baby (yes)
    
489 (97)
  
  

    
Breast milk alone can sustain a baby    for 6 months (yes)
    
500 (100)
  
  

    
The child should be breastfed    immediately after birth (yes)
    
495 (99)
  
  

    
Breastfeeding should be practiced for    6 months (yes)
    
499 (99)
  
  

    
Breastfeeding protects baby from    illness (yes)
    
500 (100)
  
  

    
Expressed breast milk should be fed    to the baby (yes)
    
489 (97)
  
  

    
Breastfeeding protects the mother    from getting pregnant (yes)
    
461 (92)
  
  

    
Solid food to be introduced at six    months (yes)
    
482 (96)
  

Table 4: Distribution of respondents according to their maternal knowledge on breastfeeding issues.

Discussion

The nutritional status and survival of children under one year of age are directly influenced by infant and young child feeding practices. To the best of our knowledge, this is the first study to assess the knowledge and practices of breastfeeding among mothers at Fajikunda Health Center (FkHC) and explore the impact of socio-demographic variables on them. Our study included 500 breastfeeding mothers from FkHC and examined their knowledge and practices related to breastfeeding.

Our findings revealed that male infants were more than the females in the study and most of the infants were less than one month old. Regarding maternal age, a significant proportion ofthe respondents fell between the age range of 21 to 25 years. This observation aligns with the cultural context in Gambia, where many women tend to get married within this age range. In terms of education, a large percentage of the respondents had completed senior secondary education (46%), while the proportion of those with a tertiary education including college or university (16%) is low. These results contrast witha cross-sectional survey conducted in Tanzania by Shirima et al. [16], where the highest percentage (73%) had attained a diploma or university level of education. The level of education may have influenced the attitudes of the mothers as higher education levels have been associated with more favorable breastfeeding practices. Furthermore, our findings indicated that a significant proportion (73%) of the respondents were married. These results are consistent with a study by Ijarotimi [17] where 93% of the mothers in a sample of 500 respondents were married.

In terms of delivery location, the study revealed that more than half (67%) of the respondents gave birth in a health facility. This rate is higher than the findings of a study by Ochola [18], where 44.3%, 78.4%, and 53.0% of mothers from three study groups delivered in health facilities. The overall rate of health facility deliveries in Kenya is 43% [2], which is lower compared to the rate of 67% in the present study. In Nepal, a lower rate of home deliveries (24.4%) was reported by Chandrashekhar [19]. Out of the mothers in the study, 84% had a normal vaginal delivery, while 16% underwent a cesarean section. The 2008-09 Kenya Demographic and Health Survey [2] also indicated a 6% rate of cesarean section deliveries in Kenya.

Regarding breastfeeding initiation, which is defined as the proportion of infants who received any breastfeeding, all the mothers in the study breastfed their infants after birth, and the rate of timely initiation of breastfeeding (within 1 hour of birth) was 63%. This rate is slightly higher (58.1%) than those reported in the 2008-09 Kenya Demographic and Health Survey and by [18].The Regional Office of WHO ENRO has reported slightly lower rates (<60%) of early breastfeeding initiation. The initiation rate within the first 48 hours was found to be 70%, which is similar to the Eastern Mediterranean [20].

In terms of receiving breastfeeding information counselling, 76% of the respondents indicated that they had received such information, while 24% had not. The sources of breastfeeding information varied, with 39% of the respondents receiving it from healthcare providers and others obtaining it from family, friends, relatives, media, and other sources. In a study conducted in Nakuru, Kenya, 64% of women reported receiving infant feeding counselling [21]. The timing of counselling sessions also differed, with 53% receiving counselling during antenatal clinics, 33% during postnatal clinics, and 14% after delivery but before leaving the health facility. These findings highlight the need to re-evaluate the promotion and support of breastfeeding at healthcare facilities. Similar results were reported in Morogoro, Tanzania, where only 17% of rural mothers and 41% of urban mothers received breastfeeding information before discharge [16]. This underscores the importance of reinforcing the implementation of the Baby- Friendly Hospital Initiative (BFHI), which mandates all maternity facilities to adhere to the ten steps of successful breastfeeding. Furthermore, it is noteworthy that a significant proportion of mothers obtain information about infant feeding from relatives, friends, and peers. In assessing respondents’ knowledge regarding breastfeeding. Our findings reveal that 99% of the respondents knew that breastmilk should be a baby’s first food. Similarly, in Uganda in a study by [22], the majority (73.8%) of the respondents were knowledgeable about exclusive breastfeeding. The findings are also consistent with those of Uchendu et al. [23] in Nigeria, where more than 90% of mothers had adequate knowledge on exclusive breastfeeding.

Colostrum, the initial thick yellow milk containing protective antibodies, is recognized for safeguarding infants against illness [2]. Timely initiation of breastfeeding, giving colostrum, and practicing rooming-in have notable benefits, including the reduction of neonatal morbidity and mortality [24]. The study’s findings align with those of Sallam et al. [25] and Ogada [26], indicating that mothers are aware of the importance of colostrum and should provide it to their infants. However, the results contrast with Adugna [27], whose study in southern Ethiopia revealed some mothers considering colostrum as expired milk, opting for pre- lacteal feeds and discarding colostrum. High rates of colostrum feeding were observed. Shirima et al. [16] also reported satisfactory knowledge among mothers regarding the importance of colostrum.

The present study demonstrates that all respondents believe breast milk alone can sustain a baby for six months and protect them from illness. This finding contrasts with a study by Webb- Girard et al. conducted among women in urban Kenya, where 77% of participants believed that breast milk alone would be insufficient for the first six months [28]. A study conducted in Malaysia reported low knowledge among respondents regarding practical aspects of breastfeeding, such as exclusive breastfeeding for six months, avoiding water after feedings, and assessing whether the baby has received sufficient milk. The same study found inadequate knowledge among respondents regarding managing breastfeeding problems like breast engorgement or the storage and use of expressed breast milk [29].

In general, this study reveals a high rate of early initiation of breastfeeding and low utilization of pre- and post-lacteal feeds, potentially due to maternal education conducted at maternal and child health clinics and positive maternal attitudes. The findings of this study differ from others, likely due to variations in contexts and the time of study. These differing contexts indicate differences in culture, health services, and study participants.

Study Relevance

The study will make a significant contribution to enhancing current health education programs related to breastfeeding. The study’s findings will play a crucial role in shaping breastfeeding policies and fostering understanding and support for breastfeeding among mothers and society at large. This will contribute to achieving Millennium Development Goals (MDGs) 4 and 5, which aim to reduce child mortality by two-thirds and maternal mortality ratio by three-quarters. Breastfeeding offers various benefits, such as preventing postpartum hemorrhage and reducing the risk of breast and ovarian cancer, thus supporting the attainment of MDG 5. Additionally, the study will serve as a catalyst for future research endeavors in the field of breastfeeding.

By generating valuable information on breastfeeding knowledge and practices, this study will be of great utility to the Ministry of Health (MOH) and other organizations engaged in child survival programs. The findings will enable them to design targeted interventions to improve breastfeeding practices in the study area and similar contexts.

Moreover, the study’s outcomes will contribute to the ongoing research efforts focused on breastfeeding and child survival. Therefore, it is imperative to identify and enhance breastfeeding knowledge and practices among mothers through a comprehensive health education program, employing various channels such as mass media, journals, drama, symposia, seminars, focus group discussions, and community diagnosis.

Limitation

One limitation of this study pertains to its generalizability. With a sample size of 500 participants, the findings may not be fully representative of the entire population in Fajikunda. The relatively small sample size restricts the ability to account for the diverse range of breastfeeding practices and cultural, socioeconomic, and geographical variations that could exist within the Fajikunda community. These factors may influence breastfeeding knowledge and practices differently across subgroups, and our study might not comprehensively capture these nuances. Therefore, while the findings provide valuable insights, they should be interpreted within the context of this specific study population.

However, it is important to note that every effort was made to ensure the authenticity and reliability of our study. Rigorous data collection methods, standardized questionnaires, and adherence to established research protocols were employed to mitigate the impact of this limitation on the study’s validity.

Future Studies

To enhance the generalizability of future studies, it would be beneficial to include a larger and more diverse sample, encompassing a wider range of demographic characteristics and geographical areas. This would provide a more comprehensive understanding of breastfeeding practices in Fajikunda and improve the applicability of the findings to the broader population.

Conclusion

The research findings presented in this study unequivocally affirm the commendable levels of maternal awareness and steadfast adherence to established breastfeeding guidelines. This robust demonstration of breastfeeding knowledge and practice attests to the conscientious efforts of maternal mothers in Fajikunda. Furthermore, the study serves to underscore the multifaceted influence of socio-demographic variables, including age, educational background, and occupation, in shaping the landscape of breastfeeding practices among mothers. It is evident that these socio-demographic factors play a pivotal role in determining not only the extent of breastfeeding knowledge but also its practical application.

Ultimately, this study contributes to the collective efforts aimed at promoting maternal and child health, thereby aligning with global initiatives to achieve the Sustainable Development Goals (SDGs).

Author Statements

Ethical Consideration

The study adhered to the ethical guidelines governing the involvement of human participants in research. Approval and consent to conduct the study were obtained from the head of the School of Public Health at Gambia College.

Informed Consent

Prior to data collection, informed consent was obtained from all respondents, who were informed that participation was voluntary, and they could withdraw at any time. Confidentiality of responses was ensured during and after data collection, as respondents were assigned numbers without requiring their names on the questionnaire. These numbers were solely used for data entry and analysis, and no individual’s identity could be linked to the registration numbers. Additionally, permission to collect data was granted by FkHC.

Data Availability Statement

The data that was generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

Funding

This research received no external funding.

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